Journal of the American Academy of Child & Adolescent Psychiatry
ARTICLESA Randomized Placebo-Controlled Trial of a School-Based Depression Prevention Program
Section snippets
DEPRESSION PREVENTION PROGRAMS
Depressive disorder usually starts in adolescence, with a marked increase in period prevalence estimates from middle to late adolescence (Fergusson and Horwood, 2001; Hankin et al., 1998), making this a good time to intervene to prevent onset. Depression prevention programs may include programs that are targeted (i.e., delivered to those at risk of disorder) or universal (i.e., delivered to the whole population). Targeted prevention programs can be divided into selective approaches aimed at
PLACEBO STUDIES
A major weakness of studies of depression prevention to date has been the lack of active comparison groups. The strength of the placebo effect in the reduction of depressive symptoms is well established (Shapiro and Shapiro, 1997). Only two reported randomized controlled trials have used an active comparison. Neither showed efficacy, but the condition described as placebo in one included active therapeutic elements (Shatte, 1997) and the other did not have power to detect a difference (Pattison
Study Participants
Participants were recruited from two different years in two schools in Auckland, New Zealand. One of these schools, school A, was from a lower socioeconomic urban area; the other, school B, was from a middle-class rural district. The schools were selected on the basis of their ethnic mix, almost purely Maori and Pakeha, and the numbers on their rolls. Most other schools in Auckland have a substantial number of students of Pacific Island or Asian ethnicity. All students in year 10 at school A
RESULTS
Of 540 students, a total of 392 (72.6%) could speak English, agreed to participate, and returned written consent forms; of these, 189/318 (59%) were from school A and 203/222 (91%) were from school B. The main reason for nonparticipation was failure to return a signed consent form from parents. We had 7 active refusals from school A and 12 from school B. The 392 students were randomized to intervention (207) and control (185). Eleven students in each group were referred to the school guidance
Summary of Findings
In this, the first substantial study to compare a depression prevention program with a placebo, we have shown a significant effect for RAP-Kiwi immediately after intervention on both measures of depression. Following RAP-Kiwi the scores remained lower at all time points at follow-up to 18 months on the RADS but not on the BDI-II when averaged across time (the area under the curve calculations). This is suggestive of a persisting effect that is small but statistically significant. We consider
REFERENCES (34)
- et al.
Examination of children's responses to two preventive intervention strategies over time
J Am Acad Child Adolesc Psychiatry
(1997) - et al.
Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: a randomized trial of a group cognitive intervention
J Am Acad Child Adolesc Psychiatry
(1995) - et al.
Preventing depressive symptoms in school children
Beh Res Ther
(1994) - et al.
Reliability and validity of the Reynolds Adolescent Depression Scale with young adolescents
J School Psychol
(1998) - et al.
Examination of preventive interventions for families with depression: evidence of change
Dev Psychopathol
(1997) - et al.
BDI-II Beck Depression Inventory
(1996) - et al.
The prevention of depressive symptoms in low-income minority middle-school students
Prevention Treatment
(2002) - et al.
School-based primary prevention of depressive symptomatology in adolescents: findings from two studies
J Adolesc Res
(1993) - et al.
A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents
Arch Gen Psychiatry
(2001) - et al.
The Christchurch Health and Development Study: review of findings on child and adolescent mental health
Aust N Z J Psychiatry
(2001)
Prevention of depressive symptoms in school children: a research update
Psychol Sci
Effects of a divorce group intervention for elementary school children
Psychology in the Schools
The effectiveness of a school-based, cognitive-behavioral stress management program with adolescents reporting high and low levels of emotional arousal
School Counselor
Development of depression from preadolescence to young adulthood: emerging gender differences in a 10-year longitudinal study
J Abnorm Psychol
A language for data analysis and graphics
J Comput Graphic Stat
School-based intervention to promote coping in rural teens
Am J Maternity Child Nurs
A universal prevention trial of anxiety and depressive symptomatology in childhood: preliminary data from a Australian study
Behavior Change
Cited by (0)
The research was supported by the Health Research Council , Grant No. 99/039 . Our thanks to the students and teachers who participated in the study; Dr. Shochet for generous support; Ms. Muller, Mr. Wharemate, Mr. Dutt, Dr. Crengle, Mr. Stewart, Mr. Leo, and Dr. Foliaki for advice over cross-cultural issues; Ms. Wills, project coordinator; Dr. Plunket, who designed the graphics; Prof. Merry and Dr. Frampton for advice about design and analysis.